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  Mirza, Bishop-koop stoma prolapse 

APSP J Case Rep 2010; 1: 24  1

I M A G E S OPEN ACCESS

 

An Interesting Case of Bishop-Koop Stoma Prolapse

Bilal Mirza

A 4-month-old male baby presented with enterostomy

prolapse. Past medical history revealed two operations

elsewhere during third week of life. The first operation

was performed for pneumoperitoneum due to necrotizing

enterocolitis (NEC) of distal jejunum. The involved portion

of small intestine was resected and a primary end-to-end

 jejuno-ileal anastomosis performed. The patient had to be

re-explored due to anastomotic disruption and then an

end-to-side jejuno-ileal anastomosis with Bishop-Koop

ileostomy fashioned [Image 1]. The patient remained wellfor three months and passed stool per rectally and

occasionally from stoma.

The patient on arrival was vitally stable with normal labs.

The general physical and systemic examinations were

unremarkable besides a prolapsed enterostomy. Patient

was anesthetized. The prolapse was inverted Y shaped,

with the first limb the original Bishop Koop prolapse of

ileal mucosa; whereas the second limb was the prolapsed

mucosa of jejunum through end-to-side jejuno-ileal

anastomosis. The mucosal anastomotic line was visible

at the proximal part of that limb [Image 2]. Initially the

  jejunal mucosa was returned back to the main stumpfollowed by reduction of ileal mucosa. U-stitches were

applied to hold the mucosa in place [Image 3]. Patient

was discharged after 2 days and appointment given for

reversal of stoma.

DISCUSSION

Enterostomies are commonly made for various pediatric

surgical conditions. Different types of enterostomies

include loop, divided/double barrel, Hartmann, santulli,

Bishop-Koop etc. These may be classified as temporary

or permanent depending upon the underlying condition

for which they have been formed [1,2].

Bishop-Koop enterostomy was originally devised for the

patients with meconium ileus, but, it has also been used

for other pediatric surgical conditions such as intestinal

atresia and NEC. Forming a Bishop Koop stoma involves

anastomosis of end of proximal bowel to the side of distal

bowel and exteriorizing the end of distal bowel as

chimney -enterostomy [Image 1] [2,3].

Image 1: A line diagram illustrating end-to-side jejuno-ileal

anastomosis with Bishop-Koop ileostomy.

The basic purpose of a Bishop-Koop enterostomy, in

patients of meconium ileus, is to provide a vent for and

irrigation of the distal bowel having thick inspissated

meconium. In other pediatric surgical conditions, it is

being used as a safety guard for intestinal anastomosis

where a diversion enterostomy is not desirable like stoma

in very proximal part of intestine and in conditions where

intestinal length is short [3]. 

Enterostomies are associated with many problems such

as; stoma retraction, prolapse, narrowing, peri-stomal

hernia/evisceration of intestine, bleeding, skin

excoriations, wound dehiscence, and so on. In one study

enterostomy related complications were about 68% in

children of different age groups. The incidence of

prolapse in pediatric patients ranges between 3% and

25%. The incidence of stoma prolapse is higher with loop

enterostomy and minimum with divided enterostomy. The

highest prolapse (25%) is observed in the distal stoma of

transverse loop colostomy [4]. 

In temporary ostomies, the stoma prolapse is usually

managed conservatively, however in cases where the

stoma is desired for a longer period or in case of

permanent enterostomy, a revision of the stoma has been

advocated [5,6].

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Image 2: The Prolapse of ileal and jejunal mucosa along with

anastomotic line of end-to-side jejuno-ileal anastomosis is evident.

Image 3: After reduction of prolapsed enterostomy. 

In a perusal of English literature through “Pubmed

website” using keywords “Bishop Koop” and “prolapse”no relevant paper was found. The prolapse of Bishop-

Koop stoma is therefore a rare event. This may be due to

a very small caliber stoma in cases with meconium ileus

where it was primarily recommended; however, in our

case, NEC was the primary diagnosis thus caliber of

Bishop-Koop stoma was not small. This contributed to the

prolapse of not only intestine but also adjacent

anastomosis.

REFERENCES

1. DelPino A, Citron JR, Orsay CP. Enterostomalcomplications: are emergently created enterostomas atgreater risk? Am Surg 1997; 63:653-6.

2. Gauderer MWL. Stomas of the small and large intestine.In: Grosfeld JL O’Neill JA Jr, Coran AG, Fonkalsrud EW,Caldamone AA. editors. Pediatric surgery. 6

thed.

Chicago: Mosby Elsevier; 2006. p. 1479-91.

3. Ziegler MM. Meconium Ileus. In: Grosfeld JL O’Neill JAJr, Coran AG, Fonkalsrud EW, Caldamone AA. editors.Pediatric surgery. 6

thed. Chicago: Mosby Elsevier; 2006.

p. 1289-303.

4. Sheikh MA, Akhtar J, Ahmed S. Complications/problemsof colostomy in infants and children. J Coll PhysiciansSurg Pak 2006; 16: 509-13.

5. Duchesne JC, Wang YZ, Weintraub SL. Stoma

complications: a multivariate analysis. Am Surg 2002;68:961-86.

6. Shellito PC. Complications of abdominal stoma surgery.Dis Colon Rectum 1998;41:1562-72.

Bilal Mirza

Address: Department of Paediatric Surgery, TheChildren’s Hospital & The Institute of Child Health Lahore,

Pakistan.

Email: blmirza@yahoo.com

Received on: 05-08-2010 Accepted on: 25-08-2010

http://www.apspjcaserep.com © 2010 Mirza

This work is licensed under a CreativeCommonsAttribution3.0UnportedLicense

How to cite

Mirza B. An interesting case of Bishop-Koop stoma prolapse. APSP J Case Rep 2010; 1: 24